Table of Contents

What Is an HIV Test?

An HIV test can tell you if you are infected with HIV, the virus that causes AIDS. There are several types of HIV tests, which are described below.

Quick Facts

Why?

Do you know your HIV status - or your partner's HIV status? If not, it is important for you to get tested for HIV. Did you just have unprotected sex, use someone else's needle, have a condom break, or learn that a previous sexual partner is living with HIV (HIV+)? Are you pregnant or planning to become pregnant? These are also important reasons to get tested for HIV. For more information on why and when to get tested for HIV, see below.

Where?

There are many different types of places for you to get an HIV test. These include health clinics, private health care providers' offices, HIV testing centers, and health departments. There are also HIV tests you can order online or buy over-the-counter at stores that have pharmacies (e.g., CVS, Walgreens, Walmart). These tests are ones that allow you to collect a sample or complete a full rapid test (20 minutes) in the privacy of your home.

In the US, you can go to the National HIV and STD Testing Resources website or the AIDS.gov website to find a testing site near you. You can also call the CDC's information line at 800-232-4636 or call your state's HIV/AIDS hotline (numbers listed here). To find services across the world, visit AIDSmap's e-atlas.

What test?

The type of test that is best for you depends on when you might have been exposed to HIV. The body takes one to three months (occasionally up to six months) to respond to HIV infection by producing antibodies. This period between infection and the production of antibodies is called the "window period." Most tests, including rapid tests done at testing centers and rapid tests you can do at home, are tests that detect antibodies to HIV. Therefore, their results are only reliable one to three months after your exposure to HIV.

If you want to get tested before the window period has passed, there are viral tests and combined antibody-antigen tests that look for the presence of HIV's genetic material in the blood and can identify an HIV infection within a few weeks of exposure. For more information, see below in "Types of HIV Tests."

What next?

If your first test comes back positive, you will need a second test to confirm or make certain that you are truly HIV+. If you have just been told you tested positive for HIV, it can feel like the worst news in the world. As upsetting as testing positive can be, you are better off knowing. Once you know you are HIV+, you can take charge of your health and have the best chance to slow or prevent disease progression.

Getting informed about HIV and its treatment will help you make the best of your situation, as will setting up a support group or finding others who share your experience (See A Girl Like Me). Today's HIV drugs enable many HIV+ people to live long, healthy lives. Therefore, it is important for you to get proper care and treatment as soon as possible. For more information, please see our Did You Just Test HIV+? article.

Why and When to Test for HIV

Getting tested for HIV is part of routine, regular health care in many countries. The Public Health Agency of Canada, for example, recommends that HIV testing be discussed as part of routine medical care. The US Centers for Disease Control and Prevention (CDC) now recommends testing all people ages 13 to 64, unless they have already been tested. It is also recommended that you get tested for HIV before beginning a new sexual relationship, regardless of your age. This is just as important for teens as it is for older adults.

The World Health Organization (WHO) makes different suggestions based on where you live. Where HIV is widespread, it recommends that HIV testing be offered to anyone who goes to a healthcare facility. Where HIV is less common, it suggests that HIV tests be offered to people who may be at higher risk of having been exposed to HIV.

Certain groups of people are considered at higher risk of HIV exposure and therefore should be tested for HIV at least once a year:

People who have multiple sexual partners or who have sex with someone who has multiple sexual partners

The "window period" – the time between infection with HIV and the body's production of antibodies to HIV – lasts between three and six months. It is important to get tested after the window period if you use a test that looks for antibodies. If you want to get tested before the window period has passed, there are viral tests that look for the presence of HIV's genetic material in the blood and can identify an HIV infection within two to three weeks of exposure.

For some, getting tested for HIV can be scary. However, it can also be a very important way to say "yes" to your life and your health. The only way to know if you have HIV (to know your 'status') is to get tested. If you are worried because you think you may have been exposed to HIV, get tested. Then, if you learn that you are negative (not infected), you can stop worrying.

The bottom line – it is important to know your HIV status and to get regular HIV tests.

Where to Get Tested

There are many different types of places for you to get an HIV test. These include health clinics, private health care providers' offices, HIV testing centers, and health departments. There are also HIV tests you can order online or buy over-the-counter at stores that have pharmacies (e.g., CVS, Walgreens, Walmart). These tests are ones that allow you to collect a sample or complete a full rapid test (20 minutes) in the privacy of your home. For more information, see below in "Types of HIV Tests").

In the US, you can go to the National HIV and STD Testing Resources website or the AIDS.gov website to find a testing site near you. You can also call the CDC's information line at 800-232-4636 or call your state's HIV/AIDS hotline (numbers listed here). To find services across the world, visit AIDSmap's e-atlas.

Types of HIV Tests

There are several different types of HIV tests, not all of which may be available in your area.

Antibody tests

Antibody tests are the most commonly used HIV tests. They look for the presence of antibody to the HIV virus in your blood, urine, or oral fluid (not your saliva). If you have been exposed to the HIV virus, your body will produce antibodies to HIV after three to six months. The period between infection and your body's production of HIV antibodies is called the "window period." Having a negative HIV test after the window period means you are not infected with HIV.

There are several types of antibody tests:

Enzyme immunoassay (EIA) test: uses blood, urine, or oral fluid to test for antibodies; results for an EIA can take up to two weeks

Rapid HIV antibody test: uses blood or oral fluid; results are available in 20 minutes. The OraQuick in-home oral HIV test is now available online or over-the-counter for at-home use. Rapid HIV tests are also available in clinics and testing centers.

Home testing kit: is not so much a testing kit as a collection kit for use at home. It tells users how to put a drop of blood on a card that they then mail to a licensed laboratory. Some kits use an oral swab, which customers must swipe along their upper and lower gums to collect a sample. Customers have an identification number to use when calling the laboratory for results. The 'Home Access HIV-1 Test System' is one such test; it takes about a week to get results.

HIV-1/HIV-2 antibody differentiation immunoassay: this test looks for antibodies in the blood; there are two versions that give results in an hour or less. It can tell if you have strain one (HIV-1) or strain two (HIV-2) of HIV, which can be important information for your provider to know when deciding what treatment is best for you. This test is now being used as the recommended second, or confirmatory test in the US.

Any positive antibody test needs to be confirmed with a second test - either an HIV-1/HIV-2 antibody immunoassay or a Western Blot. It is also important to know that at-home tests like the OraQuick and Home Access HIV-1 Test System do not provide in-person counseling or linkage to appropriate care and treatment for users who test positive for HIV.

Fourth Generation Tests: Combination Antibody-Antigen Tests

These tests combine antibody tests and DNA or antigen tests. They are better at finding recent infection (around three weeks) while still preventing false positives (results that show a person is infected when they are not). Fourth generation antibody-antigen tests are not rapid tests; they are processed in a laboratory. They use either blood or saliva, and are the recommended first-line test in the United Kingdom.

New testing recommendations released by the CDC in June 2014 now list combined antibody-antigen tests as the first-line HIV test in the US as well. If the result comes back positive, the next recommended test is no longer the Western Blot, but the HIV-1/HIV-2 antibody differentiation immunoassay. The antibody differentiation immunoassay can not only confirm the first test, but also tell which type of HIV a person has, either HIV-1 or HIV-2.

Viral DNA and RNA (nucleic acid) tests

These tests look for the presence of HIV's genetic material in the blood and can identify an HIV infection within two to three weeks of exposure. They are generally used in special circumstances, such as:

Babies born to HIV+ mothers: since babies carry their mother's antibodies in their blood for up to 18 months, traditional antibody tests would produce results that are not specific to the baby

Testing someone with a known recent exposure, before the HIV antibody can be identified in the blood

Testing people who have participated in an HIV vaccine trial: these people will already have HIV antibodies in their blood

Testing people for whom tests results have not been clear: for example, people who had a positive first test, and a negative second test (possibly because they were so recently infected)

Getting Your Test and Its Results

When you go to get an HIV test, you will generally be asked to speak first with a nurse or counselor, who will tell you about the type of test offered and make sure you would like to be tested. They may tell you about the possible test results and what they mean. They may also talk with you about how HIV is spread and how to prevent its spread through things like safer sex, using sterile needles, or cleaning drug works.

Depending on the type of test used, you will then be asked to provide a sample of blood (from a small needle inserted into a vein or a pinprick of your finger), urine (they will give you a cup to use in the bathroom), or oral fluid (they will wipe an oral swab along your gums).

If it is a rapid test, you will be asked to wait for the results (about 20 minutes). When your results are ready, a nurse or counselor will give them to you in private. Ideally, she or he will also be available to answer any questions, suggest any next steps (e.g., how to get a confirmatory HIV-1/HIV-2 antibody differentiation immunoassay if your combined antibody-antigen test came back positive, how to access to care and treatment), and address your concerns. If you use an at-home test – a rapid test or a collection kit that you mail out for results – you will not receive this type of in-person information or counseling either before or after your test.

If you test positive for HIV, there are many things you can do to stay healthy. One important thing you can do is find a good health care provider. It is also important to begin taking HIV drugs, which will help keep your immune system healthy. The longer someone is living with HIV (HIV+) and does not receive treatment, the more likely she is to have a weakened immune system, and the harder it will be for the HIV drugs to work well once she starts them. For more information for those who are newly diagnosed, see Did You Just Test HIV+?

An HIV+ person who knows her status can also do things to protect the health of others. She can tell previous sexual partners that they might be at risk of HIV infection, and she can practice safer sex to prevent spreading HIV. In addition, if she is pregnant or wants to become pregnant, she can take steps to prevent her child from becoming infected. For more information, see The Well Project's articles, Pregnancy and HIV and Getting Pregnant and HIV.

Will People Find Out if I Test HIV+?

No matter where you live, HIV testing should be voluntary (you can say no), confidential (the results are kept private), and done with a person's permission or consent. In some places, anonymous testing may be offered (you are not identified by name). Anonymous testing sites use a number or code to keep track of a person's HIV test results.

Laws about HIV confidentiality vary depending on the state and country in which you live. In the US, many states require that health care providers and testing clinics report the names of HIV+ persons to that state's department of health. The state health department is required to keep that information confidential, and it is intended to help public health officials keep better track of the epidemic. Testing sites do not share your results with any other party, including your primary care provider or insurance company.

The federal HIPAA law (Health Insurance Portability and Accountability Act of 1996) also protects the confidentiality of your HIV status in the US. It prevents health care or social service providers from sharing your HIV test results without your written consent.

Taking Care of Yourself

Getting tested for HIV is one of the best things you can do for your health. If you test negative, you can stop worrying and have a wonderful opportunity to learn how to stay HIV-negative. If you just tested positive, it is common to feel angry, scared, confused, shocked, or depressed. These feelings are normal. Please get the help and support you deserve, and know that there are many things you can do to stay healthy, including taking HIV drugs.

If you need help, check out this website to find an organization near you, whether it is a support group, a health clinic, an HIV provider, or an AIDS service organization. You can also call the US national AIDS hotline at 1-800-CDC-INFO (1-800-232-4636; TTY: 1-888-232-6348), or the AIDSinfo hotline at 1-800-HIV-0440 (1-800-448-0440; TTY: 1-888-480-3739; outside U.S.: 1-301-315-2816). To find services across the world, visit AIDSmap's e-atlas.